I'm 33 year old male. I've had years and years of symptoms which have gone on untreated and undiagnosed. Being treated by a Naturopath the last couple of years. Am on Nutri Thyroid and Thyro complex, Adrenal and GTF complex. My symptoms and thyroid results gradually improved it peaked in March 2013 and then for some unknown reason my Free T4 level crashed.
End March 2013: Felt an improvement
Free T3. 7.4 pmol/L (3.5 - 8.1)
FreeT4. 15.1 pmol/L (11 - 22) Below reference limit
TSH 0.01 mu/L (0.27 - 4.2)
Last summer, in that heat I was feeling dreadful, I had my thyroid checked and my free T4 level had dropped to 9.3 it's lowest I've known it to be.
Mid July 2013: Felt dreadful
Free T3. 4.8 pmol/L (3.5 - 8.1)
FreeT4. 9.3 pmol/L (11 - 22) Below reference limit
TSH 0.39 mu/L (0.27 - 4.2)
I'm heat intolerant symptoms seem consistent with Chronic Fatigue/ME and Fibromyalgia. I have a low basal body temp on waking 35.4oC. Muscles pain, knots, temder trigger points. Fatigue etc. I struggle to do a full days work and the symptoms are really effecting my quality of life.
Forward to Jan this year after a battle my doctor put me on a trial of thyroxine 50mcg.
I then went private and saw an Endo as I was suspecting secondary hypothyroidism, Endo agreed and ran some more tests. One of this tests was an MRI scan of my pituitary. That came back ok, although the Endo thought my pituitary wasn't releasing enough TSH. So he suggested I up my dose of Levothyroxine from 50mcg to 75mcg along with my Nutri thyroid supplements and Sertraline.
( When I showed him my results from the previous March he assumed when my Free T4 was 15.1 and my TSH was suppressed that I was on Levothyroxine, as the results were suggesting over medication.....?! He found it interesting that I wasn't on Levothyroxine and I was only on the Nutri supplements).
Anyway 6 weeks after starting the increase in dose I then went and had some bloods taken. I had two tests, NHS one which only measured Free T4 and TSH. At the same time I got the nurse to draw blood for a Thyroid Plus test which Genova Diagnostics produce. The results are as follows:
NHS Results (Taken same time as private bloods)
Serum Free T4 level 13.4 pmol/L. (11.0 - 22.0) thyroid results suggest adequate thyroxine replacement.
Serum TSH level 0.13 mu/L (0.27 - 4.2) below low reference limit
Genova Diagnostics Results 24/09/2014
Total T4. 66.1 nmol/L. ( 55 - 154) Low outside ref range but in optimu
TSH 0.113 miu/L. (0.4 - 4.0) Low outside ref range
Free T4. 12.7 pmol/L. (10 - 22) Within Optimal Range
Free T3. 6.55 pmol/L. (2.8 - 6.5) High Outside Ref range
FT4 : FT3 ratio. 1.9. (2.0 - 4.5) Low outside Reference range
Reverse T3. 0.24 pmol/mL (0.14 - 0.54) within optimal range
Thyroglobulin. <20. IU/mL (0 - 40) within optimal range
Peroxidase. 17 IU/mL. (0 - 35) within optimal range
I went back to my Naturopath and he thinks I should up my dose of Levothyroxine from 75 mcg to 100 mcg, just on a trial basis to see the effect it has on my symptoms. I wrote to my Endo to see what he would make of it if I increased my dose.
The reply I got back from my Endo was he thinks that as my blood test shows a slightly low TSH he doesn't feel there is any room for increase since this is quite likely to be an excessive dose which in itself will cause you symptoms. So he thinks I should remain on the 75mcg. He states that it may well be that the refractory nature of your residual symptoms does reflect chronic fatigue syndrome/ME which is best treated by attention to lifestyle exercise with the aim to improve physical fitness. He goes on to say that he doesn't feel at the moment there is any indication for any additional hormonal or metabolic treatments and I should continue my current dose of Levothyroxine and Sertraline.
Out of all the tests I've had the main thing I have to go on is when I felt better is when my Free T4 was 15.1 and my TSH was suppressed. I'm at a stage now where I have nothing to lose, life is passing me by and I just want to get better. I think it's going to take someone to think outside of the box and not be hung up on the blood results to get me right.
I'd really appreciate people's thoughts and experiences?
What would you do, suggest? I'm wondering whether to increase my dose from 75mcg to 100 mcg to see what or if it has any effects on my symptoms or my other option is wait till December to see the Endo to see where we go next?
Sorry for the long post.